Provider Demographics
NPI:1659885291
Name:KRISTLE J SMALL
Entity type:Organization
Organization Name:KRISTLE J SMALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:856-979-9769
Mailing Address - Street 1:105 DARLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:PA
Mailing Address - Zip Code:17560-9005
Mailing Address - Country:US
Mailing Address - Phone:856-979-9769
Mailing Address - Fax:
Practice Address - Street 1:105 DARLINGTON CT
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:PA
Practice Address - Zip Code:17560-9005
Practice Address - Country:US
Practice Address - Phone:856-979-9769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007077251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health